Acute promyelocytic leukemia (APL) with an unusual cytogenetic presentation

✍ Scribed by Yorulmazoglu, Erol; Gezer, Sefer; Gregory, Stephanie A.; Hsu, Wei-Tong

• Publisher: John Wiley and Sons
• Year: 1998
• Tongue: English
• Weight: 29 KB
• Volume: 30
• Category: Article
• ISSN: 0098-1532
• DOI: 10.1002/(sici)1096-911x(199801)30:1<69::aid-mpo17>3.0.co;2-3

✦ Synopsis

We present a patient with APL because of the therapeutic implications of the singular chromosomal rearrangement present in his leukemic cells. Our patient is a 60-year-old male who presented with easy bruisability, gum bleeding, weakness, decreased appetite, and night sweats. He is a retired admiral without significant medical history except that he was exposed to Agent Orange while he was in Vietnam. His physical was unremarkable except for multiple ecchymosis of the skin.

Admission CBC consisted of WBC 1,800/L, Hgb 8.5 g/dL, Hct 25.1%, Plt 10,000/L with the differential count showing neutrophils 5%, bands 4%, myelocytes 4%, promyelocytes 67%, blasts 7%, and lymphocytes 13%.

Sefer Gezer, MD (Hematologist)

Initial work-up also included bone marrow aspirate and biopsy demonstrating hypercellular marrow with 64% promyelocytes which was consistent with ANLL-M3 (APL). Immunophenotyping studies revealed 75% CD13, 0% CD14, 93% CD33, 0% CD34, and lymphoid markers were negative. His coagulation profile showed PT, 13.2 sec; INR, 1.3; APTT, 25 sec; fibrinogen, 435 mg/dL; FSP >40 g/mL; D-dimers, 2.0-4.0 g/mL; FV and FVIII:C were within normal limits.

Erol Yorulmazoglu, MD

Subsequently the patient was admitted with a diagnosis of ANLL-M3 (APL) with neutropenic fever. The treatment then included all-trans retinoic acid (ATRA) 45 mg/m 2 , and broad antibiotic coverage with ceftazidime, tobramycin, vancomycin.